恶性肿瘤化疗患者PICC带管期间非正常拔管的原因分析

Reasons of abnormal decannulation in patients with malignant tumor undergoing chemotherapy during PICC period

目的探究恶性肿瘤化疗患者PICC带管期间非正常拔管的原因。方法选取2012年1月-2014年6月湖南省人民医院行PICC置管进行化疗的恶性肿瘤患者291例，进行前瞻性随访调查，收集患者PICC带管期间并发症的发生情况，分析非正常拔管的原因，随访时间为1年。结果291例患者中，72例患者发生PICC并发症（24．74％），44例（15．12％）非计划性拔管，其中上肢深静脉血栓形成（UEDVT）12例（4．12％）；导管线血流感染（CLABSI）5例（1．72％），带管每1000天感染率为0．95％；穿刺处感染9例（3．09％），带管每1000天感染率为1．46％；导管脱出11例（3．78％），闭塞7例（2．41％）。单因素生存分析结果显示，既往深静脉血栓（DVT）史、化疗药物种类影响PICC置管患者的非正常拔管率。结论恶性肿瘤化疗患者PICC带管期间非正常拔管率约15％，有症状的上肢深静脉血栓是PICC非正常拔管的主要原因，单纯化疗药物输注是PICC非正常拔管的独立危险因素。

Objective To explore the reasons of abnormal decannulation in patients with malignant tumor undergoing chemotherapy during peripherally inserted central catheter （PICC） period. Methods A prospective study was conducted among 291 cancer patients who used PICC for chemotherapy in Hunan Provincial People＇s Hospital from January 2012 to June 2014. The occurrence of complications during PICC period and the reasons of abnormal decannulation in patients were investigated and collected. The time of follow- up was one year. Results Among 291 patients, there were 72 cases （24.74%） of PICC complications and 44 cases （ 15.12% ） of abnormal decannulation, among which, there were 12 cases （4.12%） of upper extremity deep venous thrombosis （UEDVT）, 5 cases （1.72%） of central line associated bloodstream infections （CLABSI） , with an infection rate of 0.95 per 1 000 catheter days, 9 cases （ 3.09% ） of exit-site infection, with an infection rate of 1.46 per 1 000 catheter days, 11 cases （3.78%） of catheter prolapse and 7 cases （2.41%） of occlusion. Single factor analysis showed that, the history of deep venous thrombosis （DVT） and the types of chemotherapeutics could influence the incidence rate of abnormal decannulation of patients with PICC. Conclusions The incidence rate of abnormal decannulation in patients with malignant tumor undergoing chemotherapy during PICC is 15%. UEDVT is the main reason of abnormal decannulation of PICC, and the chemotherapeutics infusion is independent risk factor of abnormal decannulation.